Takahata Masahiko, Ito Manabu, Abumi Kuniyoshi, Kotani Yoshihisa, Sudo Hideki, Minami Akio
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Spine (Phila Pa 1976). 2008 May 15;33(11):1199-208. doi: 10.1097/BRS.0b013e3181714515.
A retrospective review.
This study examined the clinical outcomes of circumferential spinal cord decompression through a posterior approach for thoracic ossification of posterior longitudinal ligament (OPLL), to determine the efficacy of this procedure and the incidence of complications.
Since posterior decompressive laminectomy is not always effective in the treatment of thoracic myelopathy caused by OPLL, circumferential spinal cord decompression through a single posterior approach seems to offer an effective treatment option. However, this procedure is technically demanding and has a high risk of postoperative neurologic deterioration. Long-term clinical outcome data and complication rates of this procedure are not well covered in the literature.
Medical records of sequentially treated 30 patients, who had undergone circumferential spinal cord decompression through a single posterior approach, were reviewed to determine demographic data, neurologic examination, imaging findings, surgical procedure, and follow-up data. The Japanese Orthopedic Association (JOA) score was used to assess physical dysfunction and neurologic impairment.
The mean follow-up period was 8 years; the average operative time was 389 minutes; the mean blood loss was 1883 mL. An average of 4-level spinal cord decompression was performed on all 30 patients. Posterior spinal fusion was performed on 26 of the 30 patients. The mean preoperative JOA score was 3.4/11, and it improved to an average of 7.1/11 at final evaluation. Clinical symptoms and the JOA score improved in 24 patients, but were unchanged or worsened in the other 6 patients compared to the preoperative conditions. Surgical complications included dural tear in 12 patients (40%), deep infection in 3 (10%), and postoperative neurologic deterioration in 10 (33%). Statistical analysis showed that a risk factor associated with the unfavorable surgical outcomes was multiple level circumferential spinal cord decompression of 5 or more vertebral levels.
Despite circumferential spinal cord decompression through posterior approach for thoracic OPLL providing effective neurologic recovery, there was a high rate of complications such as postoperative neurologic deterioration. Risk factor analysis shows that multiple level circumferential decompression of 5 or more vertebral levels to be associated with unfavorable surgical outcome.
回顾性研究。
本研究探讨经后路行胸椎后纵韧带骨化症（OPLL）的环形脊髓减压术的临床疗效，以确定该手术的有效性及并发症发生率。
由于后路减压椎板切除术治疗OPLL所致胸段脊髓病并不总是有效，经单一后路行环形脊髓减压术似乎提供了一种有效的治疗选择。然而，该手术技术要求高，术后神经功能恶化风险高。该手术的长期临床疗效数据和并发症发生率在文献中报道较少。
回顾连续接受经单一后路行环形脊髓减压术的30例患者的病历，以确定人口统计学数据、神经学检查、影像学表现、手术过程及随访数据。采用日本骨科协会（JOA）评分评估身体功能障碍和神经损伤情况。
平均随访期为8年；平均手术时间为389分钟；平均失血量为1883毫升。所有30例患者平均行4节段脊髓减压。30例患者中有26例行后路脊柱融合术。术前JOA评分平均为3.4/11，最终评估时平均提高到7.1/11。与术前相比，24例患者临床症状和JOA评分改善，另外6例患者无变化或恶化。手术并发症包括12例（40%）硬脊膜撕裂、3例（10%）深部感染和10例（33%）术后神经功能恶化。统计分析表明，与手术效果不佳相关的危险因素是5个或更多椎体节段的多节段环形脊髓减压。
尽管经后路行胸椎OPLL环形脊髓减压术能有效恢复神经功能，但术后神经功能恶化等并发症发生率较高。危险因素分析表明，5个或更多椎体节段的多节段环形减压与手术效果不佳相关。
